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Pembrolizumab-induced optic neuropathy – a case report
BACKGROUND: Immune checkpoint inhibitor (ICI) treatment has become important for treating various cancer types, including Hodgkin’s lymphoma. However, ICI can overstimulate the immune system, leading to a broad range of immunological side effects, known as immune-related adverse events (irAEs). Here...
Autores principales: | , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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Frontiers Media S.A.
2023
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Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10203429/ https://www.ncbi.nlm.nih.gov/pubmed/37228591 http://dx.doi.org/10.3389/fimmu.2023.1171981 |
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author | Daetwyler, Eveline Zippelius, Alfred Meyer, Peter Läubli, Heinz |
author_facet | Daetwyler, Eveline Zippelius, Alfred Meyer, Peter Läubli, Heinz |
author_sort | Daetwyler, Eveline |
collection | PubMed |
description | BACKGROUND: Immune checkpoint inhibitor (ICI) treatment has become important for treating various cancer types, including Hodgkin’s lymphoma. However, ICI can overstimulate the immune system, leading to a broad range of immunological side effects, known as immune-related adverse events (irAEs). Here, we report a case of optic neuropathy caused by pembrolizumab. CASE PRESENTATION: A patient with Hodgkin’s lymphoma received pembrolizumab every three weeks. Twelve days after the sixth cycle of pembrolizumab, the patient was admitted to the emergency department with blurred vision, visual field impairment and altered color perception affecting the right eye. The diagnosis of immune-related optic neuropathy was established. Pembrolizumab was stopped permanently and high-dose steroid treatment was immediately started. This emergency treatment led to a satisfactory binocular vision and an improvement of visual acuity testing results. After another 7 months, the left eye was affected with the same symptoms. At this time, only an extended immunosuppressive therapy consisting of high-dose steroid treatment, plasmapheresis, immunoglobulin treatment, retrobulbar injection of steroids and mycophenolate mofetil, successfully reduced the symptoms. CONCLUSIONS: This case highlights the need for prompt recognition and treatment of rare irAEs, such as optic neuropathy. Urgent treatment with initial high-dose steroid treatment is required to avoid persistent loss of visual acuity. Options for further treatment are mainly based on small case series and case reports. In our case, a retrobulbar injection of steroids in combination with mycophenolate mofetil showed significant success in treating steroid-refractory optic neuropathy. |
format | Online Article Text |
id | pubmed-10203429 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | Frontiers Media S.A. |
record_format | MEDLINE/PubMed |
spelling | pubmed-102034292023-05-24 Pembrolizumab-induced optic neuropathy – a case report Daetwyler, Eveline Zippelius, Alfred Meyer, Peter Läubli, Heinz Front Immunol Immunology BACKGROUND: Immune checkpoint inhibitor (ICI) treatment has become important for treating various cancer types, including Hodgkin’s lymphoma. However, ICI can overstimulate the immune system, leading to a broad range of immunological side effects, known as immune-related adverse events (irAEs). Here, we report a case of optic neuropathy caused by pembrolizumab. CASE PRESENTATION: A patient with Hodgkin’s lymphoma received pembrolizumab every three weeks. Twelve days after the sixth cycle of pembrolizumab, the patient was admitted to the emergency department with blurred vision, visual field impairment and altered color perception affecting the right eye. The diagnosis of immune-related optic neuropathy was established. Pembrolizumab was stopped permanently and high-dose steroid treatment was immediately started. This emergency treatment led to a satisfactory binocular vision and an improvement of visual acuity testing results. After another 7 months, the left eye was affected with the same symptoms. At this time, only an extended immunosuppressive therapy consisting of high-dose steroid treatment, plasmapheresis, immunoglobulin treatment, retrobulbar injection of steroids and mycophenolate mofetil, successfully reduced the symptoms. CONCLUSIONS: This case highlights the need for prompt recognition and treatment of rare irAEs, such as optic neuropathy. Urgent treatment with initial high-dose steroid treatment is required to avoid persistent loss of visual acuity. Options for further treatment are mainly based on small case series and case reports. In our case, a retrobulbar injection of steroids in combination with mycophenolate mofetil showed significant success in treating steroid-refractory optic neuropathy. Frontiers Media S.A. 2023-05-09 /pmc/articles/PMC10203429/ /pubmed/37228591 http://dx.doi.org/10.3389/fimmu.2023.1171981 Text en Copyright © 2023 Daetwyler, Zippelius, Meyer and Läubli https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms. |
spellingShingle | Immunology Daetwyler, Eveline Zippelius, Alfred Meyer, Peter Läubli, Heinz Pembrolizumab-induced optic neuropathy – a case report |
title | Pembrolizumab-induced optic neuropathy – a case report |
title_full | Pembrolizumab-induced optic neuropathy – a case report |
title_fullStr | Pembrolizumab-induced optic neuropathy – a case report |
title_full_unstemmed | Pembrolizumab-induced optic neuropathy – a case report |
title_short | Pembrolizumab-induced optic neuropathy – a case report |
title_sort | pembrolizumab-induced optic neuropathy – a case report |
topic | Immunology |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10203429/ https://www.ncbi.nlm.nih.gov/pubmed/37228591 http://dx.doi.org/10.3389/fimmu.2023.1171981 |
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